MEDICARE: A KIDZ DENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7535	OTHER	CO	COLORADO DENTAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366048076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A KIDZ DENTIST

Provider Business Mailing Address
First Line	:	1560 PINE GROVE RD STE C
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8004
Country	:	US
Telephone Number	:	970-879-7976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 PINE GROVE RD STE C
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8004
Country	:	US
Telephone Number	:	970-879-7976
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA HANK SALYER
Credential	:	DMD
Telephone Number	:	970-879-7976

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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Directions to “A KIDZ DENTIST ” Practice Location

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